HomeMy WebLinkAbout3755 f W .
GARFIELD COUNTY
" APPLICATION FOR BUILDING. PERMIT
PERMIT NUM R7
please print or type DATE - 77z A
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS NOTE: Show easements, property line dimensions,
SUBDIVISION all Other structures, specify north, and street
FILING # LOT # BLOCK # name. For odd shaped lots, or if space is
TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SEC /TWN /RNG)N6 y4 5,41'3 TITS R930 # OF BUILDINGS NOW ON PARCEL O
, , r
NAME ,,i'- '. - USE OF BUILDINGS NOW ON PARCEL
5 MAILING ADDRESS 1(„ e ver Pon -6-99 E. _
p CITY NCR) (ASf c . PHONE "7 -ail
■ x NAME SA,n 1• _ _
a RDDRESS CITY \ Z 5
a NAME .5 Ann r
V ADDRESS / ef--.
CITY 2-2-C
PHONE LICENSE #?-
X CLASS OF WORK p )� I ' . I I � i
NEW ALTERATION ADDITION v i
DEMOLISH REPAIR MOVE O
MOBILE HOME (make /model) I�� D e r 111
J C
S.F. OF BUILDING S.F. OF LOT 2.0...c, I L _ -
# OF FLOORS _ HEIGHT
# OF FAMILY UNITS I # OF BEDROOMS 2, �� Iq
INTENDED USE OF BUILDING faro L dtopJIi pri�/ ,
GARAGE: SINGLE DEL CARPORT: S D$'1 FRONT PROPERTY LIMB
FIREPLACE AND /AY Wmn STOYe
DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER •
WATER SUPPLY W c!I CHECK IF CORNER LOT
DRIVEWAY PERMIT N A DESCRIPTION OF WORK PLANNED
SITE PLAN
BUILDING PLANS
SANITARY SEWER CLEARANCE I hereby acknowledge that I have read this
ON SITE SEWAGE DISPOSAL PERMIT application and the above is correct and 1
OTHER DOCUMENTS (specify) agree to comply with all county ordinances
and t 1 ws regguul tiing building construction.
SIGNATURE
e ft FOR OFFICE USE ONLY
VALUATION S ,C FLOOD HAZARD
PERMIT FEE $ •3O/ e a PLA*V CHECK FEE $ l 9s %G CERTIFIED BLDG ELEVATION
TOTAL FEE $ t,4 C SCHOOL IMPACT FEE $f4 SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT .- ` e /ie D PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY
TYPE OF CONSTRUCTION 5 6V ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING ..:2 f - S.F. OF LOT Z Q t
MAX. HEIGHT -1- Z-7 / ROAD CLASS. : , _ CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT.— OR ENGINEER -
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED
if APPROVED: i , i _i' 1 1/ /ifi �/ dr " '4P - APPROVED: �
/ rLDING DEPARTM•N / D• PLA DEPARTMENT DAT